Time Of Placement Research Articles

Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: A Western Trauma Association multicenter study.

Retained hemothorax (rHTX) requiring intervention occurs in up to 20% of patients who undergo chest tube (TT) placement for a hemothorax (HTX). Thoracic irrigation at the time of TT placement decreases the need for secondary intervention in this patient group but those findings are limited because of the single-center design. A multicenter study was conducted to evaluate the effectiveness of thoracic irrigation. A multicenter, prospective, observational study was conducted between June 2018 and July 2023. Eleven sites contributed patients. Patients were included if they had a TT placed for a HTX and were excluded if: younger than 18 years, TT for pneumothorax, thoracotomy or video-assisted thoracoscopic surgery performed within 6 hours of TT, TT >24 hours after injury, TT removed <24 hours, or death within 48 hours. Thoracic irrigation was performed at the discretion of the attending. Each hemithorax was considered separately if bilateral HTX. The primary outcome was secondary intervention for HTX-related complications (rHTX, effusion, or empyema). Secondary intervention was defined as: TT placement, instillation of thrombolytics, video-assisted thoracoscopic surgery, or thoracotomy. Irrigated and nonirrigated hemithoraces were compared using a propensity weighted analysis with age, sex, mechanism of injury, Abbreviated Injury Scale chest, and TT size as predictors. Four hundred ninety-three patients with 462 treated hemothoraces were included, 123 (25%) had thoracic irrigation at TT placement. There were no significant demographic differences between the cohorts. Fifty-seven secondary interventions were performed, 10 (8%) and 47 (13%) in the irrigated and non-irrigated groups, respectively ( p = 0.015). Propensity weighted analysis demonstrated a reduction in secondary interventions in the irrigated cohort (odds ratio, 0.56 (0.34-0.85); p = 0.005). This Western Trauma Association multicenter study demonstrates a benefit of thoracic irrigation at the time of TT placement for a HTX. Thoracic irrigation reduces the odds of a secondary intervention for rHTX-related complications by 44%. Therapeutic/Care Management; Level II.

Kinetics of Symmetrical Versus Asymmetrical In-Phase Gaits During Arboreal Locomotion.

Quadrupedal animals traveling on arboreal supports change aspects of locomotion to avoid slipping and falls. This study compares locomotor biomechanics in two small mammals: first, the gray short-tailed opossum (Monodelphis domestica) predominantly trots, which is a symmetrical gait. The second species, the Siberian chipmunk (Tamias sibiricus), primarily bounds or half-bounds. Trotting and bounding differ fundamentally in three aspects: location and timing of hand and foot placement; in the way that the trunk bends (trotting, mediolateral bending; bounding, flexion, and extension); and in the dynamics of the center of mass. Both species ran on a flat track and a 2 cm diameter cylindrical track, instrumented with a force plate or pole. For bounding chipmunks, the force pole was modified to measure force only on the right side. We measured speed, duty factor, and force, and calculated vertical, braking, propulsive, and net mediolateral impulses. Vertical and fore-aft impulses were different between trotting opossums and bounding chipmunks, but between trackway types, these impulses were similar within each species. The modifications used by each species to travel on arboreal supports were similar, except in one important respect. Net mediolateral impulse in opossums changed from laterally directed on the flat trackway to medial on the arboreal. But in chipmunks, these impulses on the flat track were medially-directed, and on the arboreal track, the amount of variability was substantially greater. We conclude that chipmunks-and perhaps any bounding animal-are less consistent from stride to stride in their locomotion. This inconsistency requires constant medial and lateral impulses to correct their trajectory when traveling on arboreal surfaces.

PRIORiTize-TAVI might predict more than transcatheter aortic valve replacement waiting list priorities

Abstract Background PRIORiTize-TAVI (Predicting moRtalIty Or uRgent TAVI on waiting list) is a novel scoring system targeting identification of patients at risk of urgent hospitalization or death whilst waiting for transcatheter aortic valve replacement (TAVR) (1). Patients are divided into those with low (&amp;lt;2 points), intermediate (3-4 points) and high (&amp;gt;5) waiting risk. Given the novelty of the score, additional research is required to further validate it. However, being compiled of parameters applied in everyday practice that are readily available, the application of the score might have the potential to go beyond its original purpose. Purpose We aimed to investigate whether PRIORiTize-TAVI score can predict postprocedural complications and survival following TAVR. Methods We conducted a registry-based study including patients who underwent TAVR at our institution from 2018 to 2023. PRIORiTize-TAVI was calculated summarizing points according to NYHA status, left ventricular ejection fraction (LVEF), NTproBNP, mean pressure gradient (meanPG) and Charlson comorbidity index (CCI) at the time of patient placement onto TAVR waiting list. Results This registry-based study included 252 patients with median age 80 (interquartile range (IQR) 76-84) years, 50% female. Median PRIORiTize score was 5 (IQR 3-7). There were 41 (16%) low, 51 (20%) intermediate and 160 (64%) high risk patients. High risk patients had more frequently atrial fibrillation and ischaemic stroke, had lower LVEF and estimated glomerular filtration rate (eGFR), higher NTproBNP levels and CCI (Table 1). MeanPG also statistically differed between intermediate risk group and low risk group, but not with high risk group (Table 1). TAVR waiting time was significantly shorter in high-risk patients in comparison to intermediate risk patients. There was no statistical difference regarding baseline characteristics between the three groups (Table 1). There was no statistical difference in post-TAVR complications between the three groups. Survival significantly differed depending on PRIORiTize risk stratification (P=.023), as shown in Figure 1. Median survival time for high risk patients was 49 months (IQR 42-49), whereas the median survival time for intermediate and low risk patients could not be reached. High risk patients had lower survival probability compared to both intermediate (HR 4.089; CI 1.91-8.73) and low risk (HR 2.078; CI 0.77-5.59) patients. Intermediate risk patients had a higher survival probability compared to low risk patients (HR 0.508; CI 1.67-1.54). Length of TAVR waiting time had no significant association with overall survival (P=.891). Conclusions Our data show that PRIORiTize-TAVI has a potential to be used as a prognostic tool to predict survival probability post-TAVR. Our results suggest that prolonged time on TAVR waiting list did not negatively impact patient postprocedural complications nor survival.Table 1Figure 1

Comparing peripheral limb and forehead vital sign monitoring in newborn infants at birth.

To study the feasibility of measuring heart rate (HR) and oxygen saturation (SpO2) on the forehead, during newborn transition at birth, and to compare these measurements with those obtained from the wrist. Vital signs were measured and compared between forehead-mounted reflectance (remittance) photoplethysmography sensor (fhPPG) and a wrist-mounted pulse oximeter sensor (wrPO), from 20 enrolled term newborns born via elective caesarean section, during the first 10 min of life. From the datasets available (n = 13), the median (IQR) sensor placement times for fhPPG, ECG and wrPO were 129 (70) s, 143 (68) s, and 159 (76) s, respectively, with data recorded for up to 10 min after birth. The success rate (percentage of total possible HR values reported once sited) of fhPPG (median = 100%) was higher compared to wrPO (median = 69%) during the first 6 min of life (P < 0.005). Both devices exhibited good HR agreement with ECG, achieving >95% agreement by 3 (fhPPG) and 4 (wrPO) min. SpO2 for fhPPG correlated with wrPO (r = 0.88), but there were significant differences in SpO2 between the two devices between 3 and 8 min (P < 0.005), with less variance observed with fhPPG SpO2. In the period of newborn transition at birth in healthy term infants, forehead measurement of vital signs was feasible and exhibited greater HR accuracy and higher estimated SpO2 values compared to wrist-sited pulse oximetry. Further investigation of forehead monitoring based on the potential benefits over peripheral monitoring is warranted. This study demonstrates the feasibility of continuously monitoring heart rate and oxygen saturation from an infant's forehead in the delivery room immediately after birth. Significantly higher SpO2 measurements were observed from the forehead than the wrist during the transition from foetal to newborn life. Continuous monitoring of vital signs from the forehead could become a valuable tool to improve the delivery of optimal care provided for newborns at birth.

Assessing the efficacy of electrocardiogram for heart rate evaluation during newborn resuscitation at birth: a prospective observational study.

This study aimed to assess the efficacy of electrocardiogram (ECG) compared to pulse oximetry (PO) in detecting heart rate (HR) during high-risk newborn resuscitation. A prospective observational study was performed with high-risk delivery cases to measure the time required for HR detection. A conventional PO and a standard ECG monitor were used for HR assessment. Forty-one infants were analyzed in the study, and 11 among them needed resuscitation. Nine were <32 gestational weeks (GA), 28 were 33-35 GA, and 4 were >36 GA at birth. ECG time for placement to HR detection was significantly faster than PO detection [30 (20-43.5) vs. 125 (100-175) seconds, P<0.001]. ECG time for placement to HR detection was the fastest in the infants below 32 GA at birth [19 (11.5-30) vs. 34.5 (25-44.25) vs. 39.5 (30-64.75) seconds, P=0.039). ECG effectively evaluated HR during neonatal resuscitation compared to PO. Low gestational age infants who need resuscitation often may benefit in HR evaluation with nearby standard ECG.

A clinical study on the optimal placement depth for peripherally inserted central catheter through the great saphenous vein in preterm infants

To investigate the correlation between optimal placement depth (OPD) and physical measurement parameters in preterm infants receiving placement of peripherally inserted central catheter (PICC) through the great saphenous vein (GSV), and to establish a predictive formula for OPD during the placement of PICC through the GSV. A retrospective analysis was performed for the preterm infants who received the placement of PICC through the GSV in the Neonatal Intensive Care Unit of the Third Xiangya Hospital of Central South University from December 2022 to February 2024. According to the site of puncture [GSV of the knee joint (KJ) or the ankle joint (AJ)], they were divided into a GSV-KJ placement group (n=38) and a GSV-AJ placement group (n=33). The infants were measured in terms of body weight (BW), body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference at the time of placement. The Pearson correlation analysis was used to investigate the correlation between the above variables and OPD. A predictive formula was established for OPD in the placement of PICC via the GSV in preterm infants, and the predicted residual between the predicted depth and the ideal OPD was compared between the conventional predictive formula and the new predictive formula. The Pearson correlation analysis showed that PICC OPD was significantly positively correlated with BW, body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference in both the GSV-KJ placement group and GSV-AJ placement group (P<0.05), with the highest degree of correlation between OPD and BW. The univariate linear regression analysis showed a linear relationship between PICC OPD and BW in both groups. The predictive formulas for OPD were as follows: GSV-KJ PICC OPD (cm) = 13.1 + 2.7 × BW (kg) and GSV-AJ PICC OPD (cm) = 13.4 + 6.0 × BW (kg), and the new predictive formulas had a significantly lower predicted residual than the conventional predictive formula (P<0.05). OPD for PICC through the GSV is positively correlated with BW, and the prediction results of the new predictive formula based on BW are closer to the ideal OPD.

A New Pilot Hole Preparation System for Percutaneous Pedicle Screw Placement - A Randomized Controlled Study.

Randomized controlled study. To introduce a new pilot hole preparation system for percutaneous pedicle screw placement and investigate its efficiency and safety in comparison with the conventional method. Placing screws accurately, rapidly, and safely with less radiation exposure is critical for minimally invasive Lumbar interbody fusion (LIF). Optimizing pilot hole preparation instruments has important clinical implications. A total of 60 patients (180 screws) were included in this study. All patients were randomized into two groups (new system vs conventional method) and performed single-level minimally invasive percutaneous fixation, interbody fusion, and unilateral decompression. Basic information, time of pilot hole preparation, time of screw placement, and fluoroscopy time were recorded. Screw placement accuracy was graded based on the Gertzbein-Robbins scale, and the angle between the screw axis and the pedicle axis was collected in postoperative CT. There was no statistical difference in basic information between the two groups. The mean time of single pilot hole preparation was 4.08±1.01 min in the new system group and 5.34±1.30 min in the conventional method group (P<0.001). The time of single screw placement was significantly shorter in the new system group (0.82±0.20 vs 1.72±0.33min), and the fluoroscopy time was also less in the new system group (13.70±3.42 vs 19.95±5.50 s) (P<0.001). Screw placement accuracy assessment showed that there were 85 (94.45%) A-grade screws in the new system group while 76 (84.44%) A-grade screws in the conventional method group (P=0.027). The new pilot hole preparation system has shown significant reductions in the time of pilot hole preparation, time of screw placement, and radiation exposure, and has good clinical application value.

Comparison of the accuracy and safety of robot-and navigation-assisted screw placement in atlantoaxial dislocation surgery

Objective: To compare the accuracy and safety of robot-assisted and navigation-assisted screw placement in atlantoaxial dislocation surgery. Methods: A retrospective analysis was conducted on the clinical data of 49 patients with atlantoaxial dislocation treated consecutively at the Honghui Hospital of Xi'an Jiaotong University from April 2022 to December 2023. Among them, 27 were male and 22 were female, aged (44.2±11.7) years. Based on the date of surgery, 29 patients (from April 2022 to April 2023) received the S8 navigation-assisted screw placement (navigation group), 20 patients (from May to December 2023) received Mazor robot-assisted screw placement (robot group). The accuracy of screw placement, screw placement time, operation time, intraoperative blood loss, and intraoperative complications were recorded and compared between the two groups. The Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) score of pain were adopted to evaluate the recovery of cervical spinal cord function and cervical and shoulder pain at preoperative period and 3-month follow-up, and the occurrence of complications was observed. Results: A total of 196 screws were inserted in 49 patients. In the navigation-assisted group, a total of 116 screws were inserted with an accuracy rate of 93.1% (108/116); in contrast, in the robot-assisted group, a total of 80 screws were inserted with an accuracy rate of 97.5% (78/80) (P=0.040). The mean screw placement time, operation time, and blood loss in the navigation-assisted group were all significantly lower than those in the robot-assisted group [(37.8±3.4)min vs (48.4±4.6)min, (127.7±15.3)min vs (165.7±12.1)min and (205.8±13.6)ml vs (290.6±11.2) ml, respectively all P<0.01]. One case experienced intraoperative venous plexus injury in the robot-assisted group. Postoperatively, all patients experienced significant relief in neck pain symptoms, and neurological symptoms recovered to varying degrees. The VAS and JOA scores at 3 months post-surgery for both groups showed statistically significant improvements compared to pre-surgery (all P<0.01), but there was no statistically significant difference between the two groups (all P>0.05). Conclusions: Both robot-assisted and navigation-assisted screw placement show high accuracy and safety in atlantoaxial dislocation surgery. Compared to navigation, robot assistance increases the surgical time and blood loss, but significantly improves the accuracy of screw placement.

Comparative assessment of the stability of buccal shelf mini-screws with and without pre-drilling- a split-mouth, randomized controlled trial

ObjectivesTo examine and compare the stability of buccal shelf mini-screws using self-drilling and pre-drilling implant placement techniques.MethodologyIt was a split-mouth, randomized controlled trial comprising of 7 patients, each receiving two buccal shelf bone screws. The screws were placed using a self-drilling protocol in one quadrant and a pre-drilling protocol in the opposing quadrant decided via coin toss randomization. Stability was examined at the time of placement and 1,2, 3 and 4 months thereafter, using the Resonance Frequency Analysis method with the Osstell Beacon TM device. The Implant Stability Quotient (ISQ) obtained was then compared and assessed between both quadrants. Friedman’s Two-Way Analysis of Variance and the Wilcoxon signed rank test were utilized for the intergroup comparison. A statistically significant result was defined as one with a p-value of less than 0.05.ResultsA statistically significant difference between the mean ISQ reading in the pre-drilling and self-drilling group was observed, indicating higher stability of bone screws placed with the pre-drilling protocol. The primary stability of the buccal shelf screws decreased after placement, but the secondary stability remained stable.ConclusionBuccal shelf bone screws placed with a pre-drilling protocol depicted greater primary and secondary stability as compared to the self-drilling protocol, as depicted by the ISQ readings obtained. Resonance Frequency Analysis can be used as a valuable tool to assess the stability of buccal shelf bone screws.Clinical relevanceThe use of buccal shelf screws has increased tremendously over the past few years due to their myriad applications and have now become an essential part of an orthodontist’s armamentarium. It is therefore essential for clinicians to be well-informed about all aspects of their use including insertion techniques. The results of this trial indicate that the pre-drilling protocol provides better stability and therefore treatment outcomes.

Improving discharge times for patients admitted for allogeneic stem cell transplantation.

290 Background: Among patients admitted for allogeneic stem cell transplant (SCT) at University of Virginia (UVA) Health from 01/2022 through 12/2022, 0% were discharged by noon, even when discharge was anticipated. The discharge of SCT recipients is dynamic, impacted by events occurring throughout admission. Delays in discharge can result in patient/provider dissatisfaction, postponed admissions, additional costs, and poor utilization of healthcare resources. Methods: A multidisciplinary team of licensed providers, pharmacists, nurses and key stakeholders in the SCT program attended ASCO’s Quality Training Program in 2023, with the aim of increasing the percentage of patients discharged by noon to 20%. After review of baseline data and development of current and ideal process maps, the team distributed a survey to the department to identify perceived sources of delay. Results were corroborated with baseline data and arranged into a pareto chart and priority matrix to synthesize an action plan. The most commonly identified causes for discharge delay included: medication delivery time, complex medication issues, and delay in placing the discharge order. Results: From 10/2023 through 12/2023, the first PDSA cycle focused on anticipation of discharge and prompt placement of the discharge order, which was identified as a process measure. A discharge checklist was created via EPIC smartphrase and incorporated into daily progress notes. Data analysis demonstrated no change in the percentage of patients discharged by noon, but did show numerical improvement in the average time of discharge order placement and discharge time. The second PDSA cycle from 01/2024 through 05/2024 involved standardization of the team responsible for discharging SCT patients, with continued use of the smartphrase. Subsequently, the percentage of patients discharged by noon increased to 14.3%, with significant improvement in the time of discharge order placement and discharge time from baseline (see Table). Conclusions: Through implementation of quality improvement concepts, our team was able to improve our process measure of discharge order placement time. While we have made strides in regards to our outcome measure of percentage of patients discharged by noon, we have not met our goal yet. With continued progress and consistent auditing, we may see improvements in length of stay, bed availability, and financial burden. Future PDSA cycles are planned with an emphasis on medication delivery time. Key times during discharge for patients admitted for allogeneic stem cell transplantation. Mean Baseline PDSA 1 PDSA 2 p-value (PDSA 1 and PDSA 2) Discharge Order Time 11:46 AM 11:09 AM (p ≤ 0.304) 9:32 AM (p ≤ 0.0001) p ≤ 0.023 Discharge Time 4:20 PM 4:03 PM (p ≤ 0.559) 3:08 PM (p ≤ 0.022) p ≤ 0.239 Length of Stay (days) 26.8 25.9 (p ≤ 0.647) 26.6 (p ≤ 0.898) p ≤ 0.663 Medication Delivery Time 2:18 PM 1:00 PM (p ≤ 0.054) 12:18 PM (p ≤ 0.002) P ≤ 0.402

Gastrostomy tube (g-tube) placement timing and clinical outcomes in patients with locally advanced squamous cell carcinoma of the head and neck (HNSCC) receiving definitive chemoradiation.

37 Background: Patients with HNSCC who undergo definitive chemoradiation (dCRT) frequently require nutritional support via G-tubes; despite this, the factors associated with the timing of G-tube placement remain poorly understood. Methods: We performed a retrospective analysis of patients with HNSCC who received dCRT and required G-tube placement between 01/2018 – 01/2024. We segregated G-tube timing into two groups as determined by the intent of the treating clinician: “prophylactic” placement (ordered in anticipation of dCRT start) or “reactive” placement (ordered in response to weight loss or other adverse clinical indicators). We then evaluated associated clinical variables (patient, disease, treatment) and outcomes (weight loss, G-tube duration, healthcare utilization). Differences across G-tube groups were assessed using t-tests or Wilcoxon Rank Sum tests for continuous measures and Fisher’s exact tests or logistic regression for binary variables. Results: We identified 86 patients; 59 (69%) prophylactic and 27 (31%) reactive G-tubes were placed. At baseline, patients had a mean age of 63, BMI of 28 kg/m 2 , and Charlson Comorbidity Index of 4. Patients were 12% non-White, 2% non-English speaking, and 10% unhoused; 27% had a non-metropolitan address, 67% had public insurance, 31% were smokers and 26% had a history of alcohol dependence. The most common site was the oropharynx (66%; 75% HPV+). Across HNSCC types, 38% had stage IV disease and 60% had preexisting dysphagia/odynophagia. Most received weekly (83%) cisplatin (84%) and bilateral (95%) radiation (RT). We collected RT dose data (parotids, esophagus, pharyngeal constrictors) and found no association between RT dose and G-tube group. Patients with prophylactic G-tubes were significantly more likely to have preexisting odynophagia/dysphagia (69% vs 41%, p = 0.017). Compared to the prophylactic group, reactive G-tube placement occurred more often among patients living in non-metropolitan settings (44% vs 19%, p = 0.018) and was associated with a trend towards a higher mean percent weight loss (12% vs 10%; p = 0.128) and cachexia (per int’l criteria; 89% vs 74%, p = 0.159). We observed no difference in the median G-tube duration or in the rate of persistent G-tube use at last follow-up or death. Notably, we found that patients with reactive G-tubes were hospitalized more frequently (74% vs 36%, p = 0.001) and had a longer median length of stay (LOS; 6 vs 0 days, p = 0.001); these findings remained statistically significant when controlling for other factors (OR 3.76 [95% CI: 1.20-12.65]; p = 0.026). Conclusions: We found that reactive G-tubes were associated with increased hospitalization and LOS, suggesting that select patients may benefit from earlier G-tube placement.

Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between combined lateral position with throat pack in situ and lateral position alone

Background: Although the proper placement of nasogastric tube (NGT) is usually a simple procedure, it may be challenging one in case of its placement in anesthetized intubated patients. At times, it may be tiresome even for the expert anesthesiologist. Different techniques have varying success rates. Many novel techniques are entering the avenue to be tested. Combinations of different techniques are showing improved success rates over individual techniques. Aims and Objectives: This interventional study primarily aimed at comparing the success rates of proper placement of NGT in the first attempt between the “combined lateral position with throat pack in situ” and “lateral position alone.” Materials and Methods: The present study was performed on 180 adults (≥18 years), posted for abdominal surgeries requiring NGT insertion. Patients received NGT placement using the “combined lateral position with throat pack in situ” technique (Group A, n=80) or lateral position alone (Group B, n=80). The proportion of patients in whom correct placement of NGT was possible in the first attempt using either of the techniques (primary outcome), the procedure time for successful placement of NGT, and the incidence of adverse events were compared between the groups. Results: Correct placement of NGT in the first attempt was possible in considerably higher proportions of patients using the combined technique over lateral position alone (87.5% vs. 68.75%, P=0.007). The procedure time was comparable in both groups (23.7±6.6 vs. 25.2±5.2, combined vs. lateral position alone, P=0.093). Coiling was found to be considerably reduced in the combined method compared with the “lateral position alone” (8.75% vs.17.5%, P=0.03). Conclusion: Combined lateral position with throat pack in situ technique can be a better alternative to “lateral position alone” for NGT insertion in anesthetized, intubated adult patients.

Early placement of a non-invasive, pressure-regulated, fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study

BackgroundSince current fascial traction methods involve invasive procedures, they are generally employed late in the management of the open abdomen (OA). This study aimed to evaluate early versus late placement...

S1579 Timing of PEG Tube Placement in Stroke Patients with Dysphagia: A Multi-Center Retrospective Cohort Analysis Using the TriNetX Database

S1579 Timing of PEG Tube Placement in Stroke Patients with Dysphagia: A Multi-Center Retrospective Cohort Analysis Using the TriNetX Database

Surgical Enhancement with the Placement of Temporary Bilateral Ureteral Stents with Indocyanine Green Injection for all Stages of Endometriosis in vNOTES: Retrospective Cross-Sectional Study

Study ObjectiveTo demonstrate the time to place temporary bilateral stents with indocyanine green (ICG) injection, time to intra-operative identification of bilateral ureters - with and without the use of ICG, and number of times for ICG activation in endometriosis excision surgery. DesignRetrospective cross-sectional study. SettingSingle Tertiary Academic Hospital. PatientsFifty serial patients with functioning pelvic ureters, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES) for all stages of endometriosis excision between September 2023 and May 2024. InterventionsPlacement of temporary bilateral ureteral stents with indocyanine green injection before the start of vNOTES, noting the time needed to identify intra-peritoneal ureters with and without ICG activation, and average number of times ICG was activated for endometriosis excision. Measurements and Main ResultsThe median time to place bilateral ureteral stents with ICG injection was 229 seconds. The median time for intra-operative ureteral identification with ICG was 1s (L) and 1s (R). The median time for intra-operative ureteral identification without ICG was 17s (L) and 17s (R). The median time ICG was activated for ureteral identification to perform endometriosis excision was 12 times (L), 11 times (R). From the observations previously described, we share the potential of improved efficiency and efficacy in using ICG in ureteral identification for endometriosis surgery. ConclusionPlacement of temporary bilateral ureteral stents with ICG has the potential for more efficient ureteral identification even after including time for ureteral stent placement and ICG injection. The upfront time needed to place stents may prove to lead to a safer, more efficient procedure.

Situations and Risk Factors of Unplanned Extubation of Nasogastric Tubes in Inpatients: A Retrospective Study.

The aim of the study is to understand whether the risk factors of the unplanned extubation (UE) of nasogastric (NG) tubes vary among different inpatient situations. Inpatients who experienced UE between 2009 and 2022 at a medical center were selected, and electronic medical records were used to collect patient background data and their conditions during UE. A total of 302 patients were included in our analysis. Conscious patients were at greater risk of UE when coughing, scratching their nose, blowing their nose, or sneezing than those who were confused (odds ratio [OR] = 0.07, P < 0.001) and those who were drowsy or comatose (OR = 0.15, P = 0.026). During activity, repositioning, bathing, or changing incontinence pads, the risk of UE was higher in patients whose hands were not restrained at the time of UE than in those whose hands were restrained (OR = 0.05, P = 0.004), higher in those with companions than in those without companions (OR = 7.78, P = 0.002), and higher in those with longer NG tube placement time (OR = 1.05, P = 0.008). Accidental extubation (OR = 2.62, P = 0.007) occurred more frequently during activity, repositioning, bathing, or changing incontinence pads. There is an increased risk of UE in conscious patients during activity, repositioning, bathing, or changing incontinence pads. Patients inserted with an NG tube for a longer period of time were at greater risk of accidental extubation during activity, repositioning, bathing, or changing incontinence pads irrespective of whether a companion could aid them if their hands were or were not restrained.

Clinical and radiographic changes following transcrestal sinus augmentation: A scoping review of the last 25 years.

Maxillary sinus floor elevation is a surgical procedure intended to increase the volume of the bone vertically to accommodate dental implant placement. This intervention is frequently required for implant installation in the posterior maxilla, where the bone may be insufficient for securing implants of necessary length and stability. Sinus floor elevation can be completed either through a direct approach with a "window" through the lateral wall of the alveolar ridge or an indirect "transcrestal/transalveolar" sinus floor elevation (TSFE), which accesses the sinus floor through the crest of the edentulous ridge. Our study aims to provide a comprehensive scoping review of research conducted over the past 25 years on TSFE, specifically. A literature search aimed at identifying pertinent literature for the purpose of this PRISMA-ScR-compliant scoping review was conducted. Only randomized controlled trials, non-randomized controlled trials, prospective cohort studies, and case series that met the eligibility criteria were selected. Relevant data from these studies were extracted. Primary outcome measures included radiographic bone levels and implant failure >5 years. Secondary outcome measures included implant stability at time of placement and complications. Interventions reported in the selected studies were grouped based on treatment modality, which were then compared with the control therapy (traditional osteotome technique) after a minimum of 12 months healing period. Our search yielded 633 records, and after deduplication, 574 of these were screened. Application of the eligibility criteria led to the inclusion of 37 articles in the final selection. Case selection for included studies enrolling subjects: Four different transcrestal sinus elevation treatment modalities were identified: (a) osteotome, (b) piezoelectric surgery, (c) osseodensification, and (d) hydraulic techniques. Due to the heterogeneity of the studies, no superior approach for TSFE could be identified. Overall, all techniques demonstrated high implant survival rates. Comprehensive understanding of the patient's medical history, available armamentarium, and post-operative complications/management strategies are all essential to the completion of a successful TSFE approach for implant placement in the posterior maxilla, regardless of the treatment modality used.

CONNECT: Coordinating Options for Neurovascular Patients Needing Electrophysiology Consults and Treatments

Background and Purpose Though Event Monitors (EM) and Implantable Loop Recorders (ILR) are prevalent in stroke workups, complex processes to obtain placement of these device might result in delays. Our aim was to determine if the CONNECT (Coordinating Options for Neurovascular patients Needing Electrophysiology Consults and Treatments) pathway could improve Stroke-to-Electrophysiology (EP) communications, increase EM and ILR device placements prior to discharge, shorten placement time, and preserve satisfaction. Methods We assessed device placements when an EP consult was obtained [Pre-CONNECT (5/1/21-4/30/22), CONNECT (5/1/22-4/30/23)] for patients with stroke. In the Pre- period, consults were sent via EPIC electronic medical record (EMR), with additional direct communication when desired. In the CONNECT period, the pathway and module allowed for immediate communication between services. Outcomes included case rate, times, length of stay, and satisfaction. Hospital reports detailed Order to Activation (O-A) days. EM report review was used to obtain O-A time. Clinician satisfaction was assessed using Qualtrics survey. Patient satisfaction was assessed with Hospital Consumer Assessment of Health care Clinicians and Systems (HCAHPS) survey. Man-Whitney U test was used. Results 78 patients were included (30EM(38.5%), 48ILR(61.5%)). Age was 68 years ( P = 0.58). For ILRs, inpatient placements prior to discharge increased (3Pre vs 51 CONNECT; P &lt; 0.0001) as did outpatient placements (5 vs 16; P = 0.02). Order to Activation (O-A) time savings were significant for ILR overall (32 days vs 1 day; P = 0.03) and for Inpatient EM (13 days vs 3 days; P = 0.003). Time for consultant to view was 4 min and to respond was 6 min. Devices were placed at a median 6 hrs 32 min (EM: 4 hrs 19 min; ILR:7 hrs36 min). All (12/12) clinicians preferred the technique. Patient satisfaction improved on 13/19 (68%) questions. Conclusions There was a 1600% increase in ILR placements prior to discharge that was associated with the time period that the CONNECT process was in place. The robust improvement in ILR placements prior to discharge, high satisfaction, ease of use, closed loop communication, and respect for autonomy allowing more organic parallel discussions with patients improved clinician workflow which could potentially improve future risk reduction strategies.

Tertiary Care Center Trends in Colonic Stent Placement over the Past Decade.

Colonic endoluminal stent placement is a commonly utilized and effective endoscopic approach for the management of malignant large bowel obstruction and is an emerging approach for the management of some benign etiologies of large bowel obstruction. However, recent studies evaluating the evolution of clinical scenarios and patient populations for which stenting is performed in real-world practice are lacking. We assessed colonic stent utilization patterns in a tertiary care academic medical center over the past 10 years. We analyzed the demographics and patient and procedure characteristics of the initial (first half of study period) and latter (second half of the study period) procedures to assess trends over time using standard descriptive statistics. Our analysis was notable due to its provision of some novel insights. The frequency of colonic stent placement procedures increased significantly over time by comparison of the procedure volume for the initial 5-year interval (22 colonic stent procedures) relative to the latter 5-year interval (49 colonic stent procedures) (p = 0.03). The median age of patients who underwent colonic stent placement was significantly lower in the latter 5 years, compared with the initial 5 years of the study period (mean of 81.41 vs. 58.73 years, respectively, p < 0.001). The increased diversity of indications for colonic stent placement was also noted over time. Our data highlight the evolution of colonic stent placement in tertiary care practice over time and are notable for some interesting trends, including the increased utilization of colonic stent placement over time, the broadening of indications for colonic stent placement to include benign indications, and lower patient age at the time of colonic stent placement over time. These findings will help inform the clinical practice of colonic stent placement and provide a foundation to guide future research on the topic.

Implementation and outcomes in benign gynecological surgery with HUGO™ RAS system 12 months initial experience

We share our experience with the Hugo™ Robotic-Assisted Surgery system in benign gynecological surgeries. We retrospectively analyzed patients who underwent elective robotic surgeries for benign gynecological conditions at our surgical center from February 2023 to February 2024. Data collected included patient demographics, surgery indications, and outcomes. Perioperative data on port-placement time, arm configurations, docking, and console time were documented. Procedural outcome data including troubleshooting and overall satisfaction were also recorded. The primary outcome was perioperative data on port placement, docking time, arm configuration, and console time. The secondary outcome was defined as team satisfaction, system troubleshooting, arm repositioning, and complications graded 3–4 on the Clavien–Dindo Scale. A total of 60 patients underwent procedures for benign gynecological conditions using the Hugo™ RAS over the 12-month study period, primarily for pelvic endometriosis (53%), hysterectomies (27%), and adnexal surgery (10%). The mean port-placement time was 13 min and 41 s. In 31% of cases, low-port placement was used, with arm positioning being asymmetrical in 63% and symmetrical in 37%, demonstrating the system’s flexibility in customizing port configurations while optimizing cosmetic outcomes. Docking time averaged 5 min and 51 s, and console time was 1 h and 5 min. Operational challenges included arm tremors and limited workspace for the assistant. This study details our knowledge using the Hugo™ RAS. Learning curves of port placement, arm positioning, docking, and procedure time can be rapidly adapted in a well-trained team. Our experience suggests the technology is still in its learning curve period.